All adults under age 65 should be screened for anxiety, according to the influential US Preventive Services Task Force, which issued new draft guidelines last month. The guidelines, which help guide doctors’ decisions, are not final until a public comment period ends later this month. Still, this is the first time the national group of experts has recommended anxiety screening for such a broad swath of the American public.
How common are anxiety disorders and are there some populations more at risk than others? What are some symptoms people may have? How often should anxiety screenings occur – and what do they entail? What treatments are available? And what do these recommendations mean?
To answer these questions, I spoke with CNN Medical Analyst Dr. Leana Wen, an emergency physician and professor of health policy and management at the George Washington University Milken Institute School of Public Health. She is also author of “Lifelines: A Doctor’s Journey in the Fight for Public Health.”
CNN: How common are anxiety disorders?
Dr. Leana Wen: According to the US Preventive Services Task Force draft recommendations, the lifetime prevalence of anxiety disorders is 26% for men and 40% for women. That means about 1 in 4 men and 4 in 10 women will develop an anxiety disorder at some point during their lifetime.
This is clearly an issue that needs to be addressed. Anxiety, like depression and other mental health concerns, must be treated with the same attention that we give to physical health concerns. I’m glad that the task force has issued guidance that will raise more awareness of the need to diagnose anxiety.
CNN: How do you define anxiety?
Wen: This is an important clarification – it’s crucial to distinguish feelings of anxiety from the medical diagnosis of an anxiety disorder. Anxiety is a normal reaction to stress. Everyone feels some level of nervousness to situations in their lives.
Anxiety disorders are characterized by a persistent, excessive fear or anxiety that affects a person’s ability to function. They can lead to people avoiding situations – social engagements, professional functions, appointments or even daily errands for example – and affecting their jobs, education and personal relationships. Anxiety disorders include an array of diagnoses, including generalized anxiety disorder, panic disorder, social anxiety disorder and specific phobias.
CNN: Are there some populations who might be at greater risk for anxiety?
Wen: The presence of another mental health condition increases the likelihood of a person developing anxiety disorders. For example, depression and anxiety often overlap. One large study found that 67% of people with depression also had an anxiety disorder. There is an association, too, between anxiety disorders and smoking and alcohol use. Stressful life events such as job loss, bereavement or pregnancy could also increase the likelihood of anxiety disorders.
(The draft recommendations also acknowledge the need for further research into the prevalence of anxiety disorders in population groups defined by race and ethnicity, sexual orientation and gender identity, among others.)
CNN: What are some symptoms of anxiety disorders?
Wen: People with anxiety disorders can experience a wide array of symptoms – being restless and uneasy, feeling a sense of panic or doom, having difficulty concentrating or sleeping and experiencing panic attacks. Panic attacks are characterized by heart palpitations, shortness of breath or cold and tingly hands.
It’s important to note that a lot of people with anxiety disorders may have other physical symptoms. For example, some develop headaches, stomach aches, nausea and fatigue. Because the symptoms of anxiety disorder are so varied, underdetection and underdiagnosis are common.
CNN: How often should doctors be screening patients for anxiety?
Wen: The task force draft recommendations don’t specify. That’s because there isn’t yet enough research to say that anxiety screening needs to occur at a certain time interval. The national task force calls for a “pragmatic approach” that “might include screening all adults who have not been screened previously and using clinical judgment in consideration of risk factors, comorbid conditions and life events to determine if additional screening of high-risk patients is warranted.”
What that says to me, as a clinician, is that if we’ve never screened a patient for anxiety, it’s good practice to do it at least once. (That typically entails having patients complete a questionnaire and/or answering a series of questions during a medical appointment.) Then, depending on what else we have picked up from a patient’s changing circumstances, we may screen again. For example, we might do another screening if a patient had a recent life change, if they were diagnosed with depression or another mental health condition, or if they reported an increase in alcohol use.
Clinicians should also be on the lookout for other symptoms that may indicate an underlying anxiety disorder.
CNN: What treatments are available for people diagnosed with an anxiety disorder?
Wen: Like depression and some other mental health diagnoses, anxiety disorders can be treated through pharmacotherapy, psychotherapy, or both. Pharmacotherapy involves medications, while psychotherapy includes cognitive behavioral therapy that is done through working with a psychologist or other mental health specialist. Often, clinicians recommend lifestyle changes too, including meditation, exercise and reducing alcohol intake and smoking.
Some patients need ongoing treatment. Many receive treatment for a period of time and then are monitored to see if they might need it again.
The bottom line here is that treatments work. They reduce symptoms of anxiety disorders and help people regain wellness in their lives.
CNN: What should someone do if they think they could have an anxiety disorder?
Wen: There are online screening tools people can utilize to see if they could have anxiety, including the Generalized Anxiety Disorder scale. Anyone who think they could have an anxiety disorder should make an appointment with their primary care doctor. If they already see a mental health specialist, they could go directly to that person, too.
It’s important to tell your healthcare provider all your symptoms. Some that do not seem directly connected may actually point to an anxiety disorder. Don’t delay; remember that treatment exists and works.
If you had a physical health concern – for example, headaches due to migraines or stomach pains due to ulcers – you would want that to be addressed. Mental health concerns should be treated in the same way, with the same level of urgency.
CNN: Why do the recommendations say that screenings should be for adults under 65? What about children or older people?
Wen: The task force specifies that the evidence is strongest in supporting routine anxiety screening in adults under 65.
That does not mean that kids or older adults shouldn’t be screened for anxiety. It’s good practice for clinicians to be on the lookout for anxiety symptoms or concerns in all their patients, regardless of age – and for patients, regardless of age, to raise the possibility of anxiety symptoms to the attention of their healthcare provider.
CNN: What’s next for the task force recommendations—when will they go into effect?
Wen: These recommendations are in draft form, meaning that the task force is soliciting comments from the public until October 17. I anticipate that they will be finalized later this month.
Even then, it’s still up to healthcare providers to implement anxiety screening for their patients. I hope that the guidelines will accomplish their crucial goal of raising awareness of anxiety disorders and prompt more patients to receive treatment for this mental health concern.